If you’re stuck in the daily grind of human services delivery, leveraging evaluation data can help you see and chart your progress.
Among the most difficult things healthcare and human services professionals deal with is progress. Whether you’re an ER nurse, a front-line social worker, or a palliative care doctor, seeing progress is something that is often elusive because the nature of the job is reactionary. Even primary care physicians struggle with their work on prevention and health promotion among the many issues that they are presented with. While the work of care is important, it can also feel a little Sisyphusian.
How can we get past this when the steady stream of clients and patients create a veritable Groundhog Day? The answer is to define and demonstrate where we’re making progress using evaluation and monitoring data. You just need to set up the right system. First, let’s look at making progress — one of the most powerful motivators influencing our work.
The Progress Principle
Theresa Amabile and Steven Kramer are interested in what keeps people motivated and working in the face of challenges.
Amabile and Kramer collected nearly 12,000 daily diary entries from 238 professionals across 7 companies in various industries. These participants documented their daily work experiences, emotions, and motivation levels over several months, creating an unprecedented dataset of real-time workplace experiences.
The researchers discovered that the single most powerful motivator in the workplace was making meaningful progress on work that matters – what they termed “the progress principle.” Even small wins or “small steps forward” created significant positive effects on employees’ inner work lives, including their emotions, motivations, and perceptions. Their research found a clear hierarchy of motivators, which upended many people’s expectations about what drives workers.
It turns out, doing meaningful work and seeing progress in that work matters considerably.
Hierarchy of Motivators
When Amabile, Kramer and their team analyzed the data, the factors that most influenced positive workday experiences were:
- Progress on meaningful work (most influential)
- Catalysts (events supporting the work)
- Nourishers (interpersonal support)
- Recognition
- Incentives and rewards
These results were surprising because things like incentives or recognition were expected to be higher. Instead, the researcher’s expectations were turned on their head. Yet, it makes sense as these findings are well-aligned with the research on intrinsic motivation. What matters to us matters, and seeing progress matters as well.
In the case of much front-line health and human service work, progress is often invisible due to the nature of the interactions with patients or clients, the limited engagement or lack of control workers have over outcomes, or the lack of sightlines on the entire story. Aside from case workers or some primary care providers, few professionals have a clear sense of the entire story of their patients. In many parts of Canada for example, people don’t have access to a regular primary care physician so the person they see for care could be different each visit. This is frustrating both for the patient and the care provider.
This is where evaluation and monitoring systems comes in.
Monitoring What Matters
A strong monitoring and evaluation system designed for learning and development can be a strong asset in supporting front-line workers. Program and performance monitoring isn’t just for accountability; it’s for enabling workers to see progress toward meaningful goals (if designed properly). The over-emphasis on monitoring data for accountability has meant that many leaders (and staff) are reluctant to implement detailed systems in services.
Waiting list (movement or reduction), time of service, appropriate referrals, time to follow-up, or patient satisfaction are among the system-level variables that can be monitored and used to support motivation. When designed as part of a regular feedback system with teams that include actionable, non-punitive data on performance along with input from staff and managers.
One compelling example comes from the implementation of the Measurement-Based Care (MBC) system at Centerstone, one of the largest behavioral health providers in the U.S. Their implementation of routine outcome monitoring allowed clinicians to track patient progress in real-time and adjust treatment accordingly. This system resulted in a 20-30% improvement in clinical outcomes, reduced dropout rates by 25%, and significantly increased therapist confidence and sense of professional efficacy (Fortney et al., 2017).
The system worked by:
- Collecting routine patient-reported outcome measures before each session
- Providing therapists with visualized progress data over time
- Using automated alerts for patients not improving
- Incorporating feedback discussions into supervision
Integrating real- or near-time evaluative feedback into a system that was designed for system improvement is the key. The mistakes often made in this kind of feedback system are 1) lacking connection between inputs and actionable activities, 2) failing to provide feedback in a timely manner, or 3) using system performance data as individual performance assessments without consideration of system-level variables.
So if you’re looking to motivate, inspire and connect your staff to their work outputs in a meaningful way, consider implementing more evaluation and monitoring and building a system where it not only allows you to learn, but to activate your team as well.
References (For Further Reading)
Amabile, T. M., & Kramer, S. J. (2011). The progress principle: Using small wins to ignite joy, engagement, and creativity at work. Harvard Business Review Press. https://hbr.org/product/the-progress-principle-using-small-wins-to-ignite-joy-engagement-and-creativity-at-work/13361-HBK-ENG
Amabile, T. M., & Kramer, S. J. (2011). The power of small wins. Harvard Business Review, 89(5), 70-80. https://hbr.org/2011/05/the-power-of-small-wins
Amabile, T. M., & Kramer, S. J. (2010). What really motivates workers. Harvard Business Review, 88(1), 44-45. https://hbr.org/2010/01/what-really-motivates-workers
Amabile, T. M., & Kramer, S. J. (2007). Inner work life: Understanding the subtext of business performance. Harvard Business Review, 85(5), 72-83. https://hbr.org/2007/05/inner-work-life-understanding-the-subtext-of-business-performance
Ryan, R. M., & Deci, E. L. (2020). Intrinsic and extrinsic motivation from a self-determination theory perspective: Definitions, theory, practices, and future directions. Contemporary Educational Psychology, 61, 101860. https://doi.org/10.1016/j.cedpsych.2020.101860
Fortney, J. C., Unützer, J., Wrenn, G., Pyne, J. M., Smith, G. R., Schoenbaum, M., & Harbin, H. T. (2017). A tipping point for measurement-based care. Psychiatric Services, 68(2), 179-188. https://doi.org/10.1176/appi.ps.201500439
Related Academic Articles
Amabile, T. M., Schatzel, E. A., Moneta, G. B., & Kramer, S. J. (2004). Leader behaviors and the work environment for creativity: Perceived leader support. The Leadership Quarterly, 15(1), 5-32. https://doi.org/10.1016/j.leaqua.2003.12.003
Amabile, T. M., Barsade, S. G., Mueller, J. S., & Staw, B. M. (2005). Affect and creativity at work. Administrative Science Quarterly, 50(3), 367-403. https://doi.org/10.2189/asqu.2005.50.3.367
Amabile, T. M., Fisher, C. M., & Pillemer, J. (2014). IDEO’s culture of helping. Harvard Business Review, 92(1-2), 54-61. https://hbr.org/2014/01/ideos-culture-of-helping
Methodological Papers
Amabile, T. M., Mueller, J. S., Simpson, W. B., Hadley, C. N., Kramer, S. J., & Fleming, L. (2002). Time pressure and creativity in organizations: A longitudinal field study. Harvard Business School Working Paper. https://www.hbs.edu/faculty/Pages/item.aspx?num=13311
Amabile, T. M., & Kramer, S. J. (2011). The Progress Principle: Using Small Wins to Ignite Joy, Engagement, and Creativity at Work. Harvard Business School Working Knowledge. https://hbswk.hbs.edu/item/the-progress-principle-using-small-wins-to-ignite-joy-engagement-and-creativity-at-work
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